Rational Pharmacotherapy in Cardiology

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Vol 11, No 6 (2015)
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558-560 851

The TRIPOD Statement aims to improve the transparency of the reporting of a prediction model study. This document describes the rationale; clarifies the meaning of each item; and discusses why transparent reporting is important, with a view to assessing risk of bias and clinical usefulness of the prediction model. To aid the editorial process and help peer reviewers and, ultimately, readers. The editorial board of "Rational Pharmacotherapy in Cardiology" hopes that the ability to publish TRIPOD will be useful to our authors, reviewers and readers.


561-570 800

Myocardial infarction significantly contributes to mortality rates in patients with chronic obstructive pulmonary disease (COPD). The influence of COPD on the course of acute ST-segment elevation myocardial infarction (STEMI) is controversial.

Aim. To evaluate characteristics of coronary artery lesions and cardiovascular complications in STEMI patients with and without COPD depending on a reperfusion treatment method during in-hospital stay.

Material and methods. A total of 1112 cases of STEMI treatment within the first 6 hours of the symptoms onset were analyzed. All of these patients have undergone reperfusion treatment: primary percutaneous coronary intervention (PPCI) or pharmacoinvasive strategy (PIS) methods. All the patients were divided into two groups: patients without COPD (952 persons; 83.2%) and those with COPD (160 patients; 16.8%). COPD impact on in-hospital course of STEMI was assessed.

Results. The presence of COPD had no influence on STEMI in-hospital mortality. Mortality rates in patients with COPD (12 subjects; 7.5%) and without COPD (83 subjects; 8.7%) did not differ significantly (p=0.2). The study has demonstrated the significant influence of COPD on the patients’ baseline characteristics and treatment results, which can have an impact on long-term prognosis. According to our data COPD presence was associated with more severe coronary artery lesions in both PPCI and PIS subgroups (p<0.001). This has determined more frequent transmural myocardial damage in STEMI patients with COPD regardless of reperfusion strategy and time factor (79% in patients with COPD and 50% in those without one, p<0.001). The incidence of hemorrhagic complications also didn’t depend on COPD presence and remained low in all groups.

Conclusion. At COPD presence STEMI was associated with more severe coronary artery lesions and increased frequency of transmural myocardial damage and residual stenosis after thrombolytic therapy. COPD did not lead to the increase in in-hospital mortality rates in STEMI patients undergoing reperfusion treatment.

571-576 1017

Aim. To study the incidence of comorbidities and their impact on the prognosis in patients with ischemic heart disease (IHD) included into the PROGNOZ IBS Register.

Material and methods. Data from the PROGNOZ IBS register of patients diagnosed with IHD using coronary angiography during the reference hospitalization (n=541; 432 male and 109 female) was included in the analysis. 504 (93%) patients were included in the survival analysis. Risk factors of cardiovascular diseases, associated with atherosclerosis, or those that were complications of IHD were considered as comorbidities as well as not cardiovascular diseases – chronic obstructive pulmonary disease, bronchial asthma and
chronic kidney disease (CKD).

Results. The average duration of follow-up was 7.3±2.19 years. The average number of comorbidities in patients with IHD was 1.83. Comorbidities worsened the prognosis of life: the presence of diabetes mellitus (DM) increased the relative risk (RR) of primary endpoint occurrence by 1.7 times, the combination of DM with hypertension – by 2.4 times, a history of stroke – by 2.3 times (p<0.05); 2 and 3 heart diseases – respectively, by 2.3 and 3.2 times (p<0.05); a combination of chronic lung diseases and CKD stages 3-5 – by 1.4 times (p=0.06); the presence of 2, 3, 4 and 5 comorbidities – respectively, by 4, 5, 6.4 and 13 times (p<0.001). The risk of death from all causes was determined by the number of concomitant cardiovascular diseases: 2 diseases increased RR by 2.3 times, 3 diseases – by 4.6 times, a combination of any 4 diseases – by 3.5 times, of 5 diseases – by 5 times (p<0.05).

Conclusion. Prognosis of life in IHD patients is worsened by the presence of several comorbidities: risk factors of cardiovascular disease (DM and hypertension), cardiovascular diseases associated with atherosclerosis or those that are complications of IHD, chronic lung diseases and CKD.

577-581 1366

Chronic heart failure (CHF) and atrial fibrillation (AF) can rightly be called the epidemic of the XXI century, which are associated with high morbidity and mortality of patients. Common risk factors and pathophysiological mechanisms explain the frequent combination of CHF and AF. So far, a number of issues related to management of these patients, remains unresolved. Data on compliance with clinical guidelines and the prevalence of long-term anticoagulant therapy in this group of patients in our country is limited. The first Russian register of CHF and AF (RIF-CHF) is initiated in order to better address this problem. The results allow to develop the most rational therapeutic and diagnostic strategies and, ultimately, to improve the clinical outcomes of such severe patients.

582-589 791

Aim. To study the frequency and characteristics of alcohol use in outpatients with cardiovascular diseases and to determine their preferences regarding the help in limiting alcohol consumption.

Material and methods. Voluntary and anonymous survey using AUDIT-C and CAGE questionnaires was conducted in 199 patients. The data of 182 patients (82 women and 100 men, mean age 56.4±5.8 years) was included in the analysis.

Results. Arterial hypertension (70%), heart rhythm disorders (25%), ischemic heart disease (20%), functional class I-II chronic heart failure (21%) predominated among all clinical entities. Positive AUDIT-C test was found in 30% of men and 7.3% of women. 17% of men and 23.2% of women did not use alcohol at all. Positive responses to all 4 questions of the CAGE test were given by 3% of men and none of women, positive answers to 3 questions – by 15% of men and none of women, to 2 questions - by 17% of men and 11% of women. Positive answer to the question about the need to reduce alcohol consumption was given by 36% of men and 13.4% of women.

Conclusion. Simultaneous testing using AUDIT-C and CAGE questionnaires in outpatients with cardiovascular diseases allows identifying a subgroup of patients (more in men) who have a potential problem with an excessive alcohol consumption and need to reduce the intake of alcoholic beverages.

590-594 669

Aim. To study the prevalence of renal and renovascular disorders in the development and progression of primary arterial hypertension (HT) resistant to combination antihypertensive therapy (AHT) in cardiac and therapeutic patients of general hospital.

Material and methods. 286 patients with essential HT stages 1-3, including 105 patients with stages 2-3 with the signs of treatment resistance were included into the study. All patients were treated with personalized AHT in accordance with current guidelines for the management of HT. Laboratory and instrumental assessment of a functional status of kidneys was performed.

Results. A group of patients with resistant HT made 36.7% of the total number of examined patients. The most significant distinction in patients with resistant HT was a high incidence of changes in renal vessels and infrarenal aorta. Deformation of the abdominal aorta (9.7%), renal arteries tortuosity (7.3%), vasourethral conflict (4.8%) were detected in this group significantly more often.

Conclusion. Congenital and acquired lesions of renal arteries are detected several times more often in patients with resistant essential HT.

595-600 756

Aim. To study left ventricular (LV) remodeling, interventricular and intraventricular asynchrony in isolated inferior LV myocardial infarction (MI) or combined inferior LV MI with right ventricular (RV) MI.

Material and methods. 57 patients with inferior LV MI with or without RV MI (n=57) were included in a 6-month prospective study. The patients were divided into 2 groups: Group 1 - patients with inferior LV MI (n=30); Group 2 - patients with inferior LV MI in combination with RV MI (n=27). Electrocardiography and echocardiography were performed in all patients at admission, on days 3, 30 and 180 after MI.

Results. Significant signs of diastolic dysfunction (RV end-diastolic area 29.21±2.0 cm2) were found in group 2 on the third day after MI. A significant increase in the LV volume indices and diastolic sphericity index (from 0.54±0.02 to 0.59±0.03 units) and an increase in interventricular asynchrony (from 37.4±4.2 to 44.6±4.2 ms) were found in group 2 in 30 days after MI. Increasing tendency towards intraventricular and interventricular asynchrony, despite the absence of pathological LV remodeling, occurred in group 2 in 6 
months after MI.

Conclusion. Patients with RV MI have more pronounced maladaptive LV remodeling, intraventricular and interventricular asynchrony and greater LV diastolic dysfunction.


601-606 794

Aim. Pharmacoeconomic analysis of apixaban use compared to conventional therapy in patients with venous thromboembolism (VTE).

Material and methods. Economic evaluation was performed from a position of the health care system. The cost analysis, "cost-effectiveness" analysis, "impact on the budget” analysis, and sensitivity analysis were fulfilled.

Results. In real clinical practice in hospitals direct medical costs of apixaban treatment of deep vein thrombosis and pulmonary embolism make up 2331.67 and 3142.98 rubles, respectively, while the costs of the standard therapy - 6192.15 and 6225.75 rubles. Potential resource savings will reduce 2.65 times the cost of the health system. The share of the costs of treatment of adverse effects (bleeding) in the conventional therapy group was 4.8 times higher than the costs in apixaban group. The results of analysis of the effect on the budget show a decrease in the load on the budget when apixaban was included in the treatment regimen of VTE. Potential resource savings of the health system in the treatment of 1,000 patients with apixaban will account 3,911,860 rubles in comparison with conventional therapy.

Conclusion. The inclusion of apixaban in the therapy of VTE can significantly reduce the burden on the budget of the health care system.


607-609 723
The case study of contrast-induced acute kidney damage in patient with acute coronary syndrome and complex comorbidity with poor prognosis is presented.
303-306 132

Adequate primary and secondary prevention of thromboembolic complications is one of the main goals of management of patients with atrial fibrillation. Many years of practice and experience of warfarin use, unfortunately, did not lead to wider and more efficient use of anticoagulation therapy. New oral anticoagulants devoid of drawbacks of warfarin, which prevented its prescription and long-term use, have appeared in the past few years. One of them, the most studied, with the largest list of indications for use, and very attractive, is rivaroxaban.


610-617 920

Clinical case of successful chemotherapy of patient with cardiac involvement in lymphoma, one of manifestations of which was the heart rhythm and conduction disorder, is presented as illustration. The data on the epidemiology of cardiac involvement in hematologic diseases, particularly in lymphomas and their clinical manifestations, modern diagnostic and treatment are presented. Clinical case of successful chemotherapy of patient with cardiac involvement in lymphoma, one of manifestations of which was the heart rhythm and conduction disorder, is presented as illustration.


618-625 1116

The aim of this review was to study a problem of outpatient non-attendance by the analysis of relevant literature data. Pubmed and Cyberlenica articles and abstracts, published in 1966-2015, concerning the problem of non-attendance at outpatient clinics and cardiac rehabilitation programs, were used as data sources. The search included articles that reviewed the prevalence of outpatient non-attendance, reasons for it, it’s effect on disease outcomes and search for possible ways of its correction. The problem of patients’ non-attendance at outpatient clinics and cardiac rehabilitation programs is urgent in many countries and depends on various factors. This problem is best studied from a perspective of its causes. Factors related to the patient himself play the major role, although the influence of factors related to hospital and doctor’s characteristics also significantly contribute to the problem. Various methods to improve attendance were suggested. Causes that can be effected by the patient himself or by the doctor at visits: forgetfulness, lack of awareness and motivation. There are few studies that evaluate the effect of non-attendance on medication adherence and outcomes of diseases. Non-attendance at healthcare clinics is a common and urgent issue all over the world. It can affect medication adherence, which is crucial for a long-term regular primary and secondary preventive therapy of cardiovascular diseases. Study of non-attendance at healthcare clinics is an important scientific and clinical problem.


626-633 804

Achievements of interventional cardiology in the treatment of coronary artery disease are based on coronary balloon angioplasty with implanting bare metal stents and drug eluting stents. Questions of complications such as early stent thrombosis and restenosis of stent were solved in a considerable degree. However, with the lengthening of the followup period, the problem of late complications became obvious. Except endothelization and fibromuscular proliferation in stented coronary arteries the process of plaque formation has an important influence on later complications in follow-up period more than one year. This process was defined as neoatherosclerosis. This is verified by clinical manifestations of the disease, histological studies, angioscopy, intravascular ultrasound and optical-coherence tomography in stented patients. Dynamic observation of the condition in stented
coronary arteries showed multistep proliferation with restenosis, its regression, and neoatherosclerosis development. Evidences of neoatherosclerosis formation in stented coronary arteries are considered in this review.


634-637 975

A hypothesis that possible pleiotropic features of different statins could be explained by distinctions in their interaction with cell membrane is suggested. Molecular complexes of pravastatin and simvastatin with model of cell membrane were studied by method of nuclear magnetic resonance spectroscopy. It was shown that pravastatin interacts almost exclusively with a surface of cell membrane and, therefore active transport system is needed to deliver pravastatin into the cell. In contrast, simvastatin is located in the inner part of model cell membrane. That’s why it can passively penetrate into organism cells. Perhaps, these differences lead to distinctions of pleiotropic properties of these statins.


638-642 996

The non-compact left ventricular cardiomyopathy (NCLVC) refers to the non-classified cardiomyopathies. Its cause is not completely clear. NCLVC is characterized by an increased trabecular with the formation of deep intertrabecular crypts. It can exist either in isolated form or in combination with other congenital diseases. The clinical features of NCLVC are different: asymptomatic forms are identified as well as forms with the progressive course of the disease, with heart failure, angina, thromboembolic complications, and ventricular arrhythmias. In some cases, the disease starts with the sudden cardiac death. The sudden decompensation of NCLVC also could arise due to the development of acute myocarditis

643-649 777

Role of pharmacoinvasive tactics in the treatment of patients with ST-segment elevation acute myocardial infarction is considered. The expert opinions reflected in the final version of the guideline are given, as well as the results of clinical trials in which the efficacy of thrombolytic therapy at early stage after acute myocardial infarction onset compared
with primary percutaneous coronary intervention. The place of pharmacoinvasive tactics in real clinical practice is discussed.


650-654 878

Modern clinical studies periodically open new prospects for the use of well-known products, lighting other facets of the point of application of these drugs. Application of the last representatives of sartans, not only as a drug with proven antihypertensive effect, but also in terms of their effects on metabolic processes, can be considered as such an example.


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